Medicaid Isn’t Just About the Finances

            It’s something I always remind clients when we talk about Medicaid eligibility.  Meeting the income and asset limits are not the only requirements.   An applicant must also be medically eligible.

             What does that mean?  An applicant must establish the need for nursing home level care, needing assistance with the activities of daily living.  It’s one of the reasons why the planning that we do is so important.  If I run out of money before my health is bad enough for me to need long term care, I won’t be able to get New Jersey Medicaid to help me.  It’s a very common scenario, one which I was reminded of last week.

              We received a call from Jim regarding his dad, who has been living with Jim for the last several years.  Dad is bipolar but functions well when he takes his medications.   It often is a struggle, however, to get him to take that medication.  Jim works during the day so he isn’t always at home to  monitor Dad.

               Jim explained that his dad becomes somewhat agitated and occasionally wanders when he is “off his meds”.  When I asked about his ability to walk, eat, bath, dress and toilet on his own, Jim replied that this isn’t Dad’s problem.

               Jim called because he wants to move Dad to an assisted living facility, feeling that he needs more supervision.  But, Dad only has a few thousand dollars to his name so his plan is to apply for Medicaid, which is the reason he called.

               There are several problems with Jim’s plan.  He hasn’t even begun to look at facilities but when he does he will likely find the choices limiting.  It is not easy to get into a facility on Medicaid right away.  Most assisted living facilities make their Medicaid “slots” available to longtime residents who have spent down assets while at their facility.  Although there are a few that will take a person on Medicaid right away, none happen to be in Jim’s immediate area.

                I told Jim the best solution for now is to hire someone to come to his home for a few hours a day while he is at work.  The cost won’t be covered by Medicaid but that’s one of the reasons that getting government benefits is so tricky.  The rules are complicated and the government  – not you – decides whether it will provide you with assistance.  And in Jim’s case, the answer is “not yet”.  He’ll have to go it alone for now.